Provider Demographics
NPI:1043289721
Name:GRAHAM, HURLIS VONDALE (MD)
Entity Type:Individual
Prefix:DR
First Name:HURLIS
Middle Name:VONDALE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5405
Mailing Address - Country:US
Mailing Address - Phone:918-748-7585
Mailing Address - Fax:918-748-7539
Practice Address - Street 1:1515 N HARVARD AVE
Practice Address - Street 2:STE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-4957
Practice Address - Country:US
Practice Address - Phone:918-832-6049
Practice Address - Fax:918-832-6055
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK10072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100071120AMedicaid
OK100071120AMedicaid